HONG KONG—Amid a global slowdown in new HIV infections, sex workers and gay men in East Asia are increasingly vulnerable to the virus, in a region where access to treatment is still below the world average.

Six million households will be forced into poverty by HIV/AIDS in the next five years, with fast-growing infection rates among female sex workers and men who have sex with men, according to the United Nations' latest global AIDS update.

"In many Asian countries, sex workers are at an extremely high risk of infection," the UNAIDS report said, saying the use of condoms was still not consistent around the region.

"In [Burma], for example, more than 18 percent of female sex workers are infected with HIV...Since condoms are not consistently used during sex work, sex workers have an elevated risk of becoming infected, which in turn can result in subsequent transmission to their male clients," it said.

Recent studies have shown that 60 percent of female Chinese sex workers do not consistently use condoms with their clients, which UNAIDS warned could fuel future HIV outbreaks.

And officials from China's Centers for Disease Control and Prevention have described an "explosion" of HIV infections among men who have sex with men.

More discussion

Beijing-based AIDS expert Wan Yanhai, who founded the AIDS charity Aizhixing, said he welcomed the fact that Chinese health authorities were willing to discuss the issue of sexual transmission of AIDS, and especially rising infection rates among gay men.

"However, there are some aspects of their description which are somewhat imprudent," Wan said, as Chinese president Hu Jintao visited HIV charities and state media ran sympathetic feature stories about AIDS orphans and gay men.

"What sort of an impact will this have on the way that homosexual men are seen by the general public? I think that it may well increase discrimination against them."

Guiyang-based China AIDS Info Web site founder Nong Zhijun, who does outreach work with men who have sex with men in the city's clubs and bars, said infection rates among that group had skyrocketed from just over 2 percent to more than 10 percent in two years.

"I am not really sure why [the infection rate is rising], because when we had just got started it was still very low," said Nong, who said his group sometimes collaborated with government health officials.

"It might be something to do with our sample sizes. They were a bit smaller two years ago and larger in the second survey two years later," he said.

"Also, I can't be sure that we haven't got some results reported twice from our survey here in Guiyang."

'Several-fold' increase

But Wang Long, head of the Hangzhou branch of the HIV patient support group Ark of Love, said the infection rate among men who have sex with men in China was showing a marked increase.

"It's not just rising fast, it's risen several-fold...In Hangzhou, the infection rate is more than 10 percent," said Wang, who said government neglect of the gay community in its HIV prevention strategy was one factor in the rise of infections.

"Government health officials don't pay enough attention to the issue, because they don't regard this section of the population, or gay grass-roots organizations, as important," he said.

"We hope that the government will extend financial assistance to voluntary organizations, and especially give those organizations a more liberal space in which to operate, and not to take oppressive measures against them," he said.

"We are very happy to carry out our work in conjunction with government departments, but the government doesn't support organizations like ours."

The UNAIDS report appeared to back up Wang's view.

"The failure of many national programmes to prioritize prevention services for populations at higher risk is especially worrisome," it said, citing a 2008 report from the Commission on AIDS in Asia.

Access to treatment was also poor, the report said.

"As of December 2008, 37 percent of those in Asia needing antiretroviral therapy were receiving it...somewhat below the global average (42 percent) for all low- and middle-income countries."

Vietnam network

In Vietnam, where some 42,000 people have died of AIDS, the government has set up a nationwide network of HIV/AIDS treatment centers, funded by the United States President's Emergency Plan for AIDS Relief (PEPFAR).

According to the PEPFAR Web site, "stigma and discrimination pose a major challenge to fighting the HIV epidemic," while injecting drug use is a major factor driving the spread of HIV in Vietnam.

While the country enjoyed a relatively high number of trained healthcare workers, there were "serious gaps" in its capacity to implement AIDS prevention policies.

"There is now a system up and running in all of Vietnam's 63 provinces," Nguyen Dac Vinh, manager of research science at the Health Ministry's AIDS prevention department, told reporters.

"These are the management units for HIV/AIDS in each province, each locality and each city."

"Patients with AIDS can be treated in more than 200 outpatient clinics and at general hospitals in the provinces... Antiretroviral therapy in Vietnam is completely free," Vinh said.

One AIDS patient in Hanoi said the lives of Vietnamese living with HIV had been considerabley improved in recent years.

"PEPFAR funding supports HIV drugs free for children, and now they have some drugs to treat opportunistic infections, so this has significantly improved the lives of people infected with HIV in Vietnam," she said.

"Deaths have especially been reduced in the past three years, with people not progressing to the later stages of AIDS, and able to live healthy lives, and work."

While 25 million people have died of AIDS worldwide, new infections are slowing sharply, according to UNAIDS.

Prevention programs are showing a marked slowdown in new infections, although nearly 60 million people have been infected by the HIV virus since it was first recorded.

Last year saw some 2.7 million new infections. Globally, 33.4 million people are believed to be living with HIV.

Original reporting in Mandarin by An Pei and in Vietnamese by Quynh Nu. Mandarin service director: Jennifer Chou. Vietnamese service director: Khanh Nguyen. Translated and written for the Web in English by Luisetta Mudie. Edited by Sarah Jackson-Han.

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